Study Reveals Connection between Chronic Pain and Anxiety

New research reveals a little-understood connection between chronic pain and anxiety, and offers a potential target for treatment, according to a release from the University of Vermont.

University of Vermont (UVM) researchers published their findings as an Article in Press in Biological Psychiatry. Their study revealed that increased expression of PACAP – a peptide neurotransmitter the body releases in response to stress – is also increased in response to neuropathic pain and contributes to these symptoms.

The researchers examined the expression of PACAP (pituitary adenylate cyclase activating polypeptide) along one of the nervous system’s pathways to the brain – the spino-parabrachiomygdaloid tract – which travels from the spinal cord to the amygdala, the brain’s home base for emotional behavior.

Using models for chronic pain and anxiety, as well as models that can trace PACAP neurocircuits, the team members were able to observe where the stress and chronic pain pathways intersected.

“Chronic pain and anxiety-related disorders frequently go hand-in-hand,” says senior author Victor May, Ph.D., professor of neurological sciences at the University of Vermont. May and members of the research team found that PACAP was also highly expressed in women exhibiting PTSD symptoms, in a 2011 study.

While May and his colleagues saw an increase in anxiety-related behaviors in models of chronic pain, the anxious behavior and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist – designed to block the response – was applied.

“By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders,” says May, whose next step is to work with University of Vermont chemistry colleagues to develop small molecule compounds that can antagonize PACAP actions.

“This would be a completely different approach to using benzodiazepine and opioids – it’s another tool in the arsenal to battle chronic pain and stress-related behavioral disorders.”

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This is very exciting!
As an RA patient on the end game of my fourth biologic medication I’m reasonably versed in the targeting of pathways to modify disease process. I use Norco and clonazepam regularly in addition to Cimzia and Arava. For researchers to be closing in on a targeted small molecule (non-biologic) modifier for both chronic pain & anxiety is a big deal.
Established chronic pain and anxiety is a bit of a chicken/egg gig, with both eventually interacting symbiotically- to the demise of ‘we the patient’.

Now stay with me here as I try to explain the acute vs chronic pain link with anxiety:
My first severe RA flare was in my right shoulder, it started out of the blue and was disabling in less than an hour, it was a Sunday night. The pain was horrendous, the night stretching on until finally my husband could take me to the family doc. After some tests it was thought to be bursitis. My pain was highly stressful the previous night, but now I had a diagnosis, one that would heal with time, my stress vanished even though the pain didn’t. How is that possible?
My brain was only feeling acute pain or “healing” pain – FINITE pain.
Of course when I started to flare in multiple joints and was diagnosed with seropositive RA, the stress went through the roof. Even though I responded rapidly to my first biologic, Humira, and the disease was controlled within 3 months, the damage was done psychologically. I slipped into major depression with a side of anxiety. It took two years before I started to rise, and another three years to really start living again.

I used to get so mad when I’d read about a study saying chronic pain was worse in depressed patients- wtf? Seriously people? I knew, KNEW that it was my pain causing my depression and anxiety. But now, years later, I’m pretty sure they were right. Could they have written papers that were less insulting to patients? YES! But they were writing these papers for their peers to read, not the patients; and do I want researchers to spend time worrying about upsetting us when that time is better spent finding a way to help us? No, of course not. Let them work. Let them help.

This article was both gentle to my delicate dignity while lighting that fire called hope simultaneously- well done!

Gosh, imagine that?!! They could have saved the money and just surveyed us!! Depression and anxiety are NORMAL, repeat NORMAL parts of the losses that come with persistent pain! Let alone the pain itself being something to be anxious and depressed about! Wouldn’t it be insane to be peaceful and happy about having pain!?? Or experiencing pain?! Glad they have it all figured out, except now they will label it a disease process and treat us for anxiety and depression!! That would be so wrong! Unless these two issues escalate to actual clinical heights, they are best left for the person to process, learn about, and adjust to! It’s part of life with pain!

Pain and anxiety a ” new study?”, that is somewhat difficult to believe. My friend, a nurse back in the seventies was taught in order to treat the pain you must treat the anxiety that goes along with it. Pain meds alone will not manage pain if the anxiety level is through the roof. That was documented many years ago, so how can they call that a new study? All this. Study, research and guidelines are going backwards not forward. Insurance companies and politicians making the call as to what a chronic pain patient needs, I am actually lost for words on that one. From what I can see through my own experiences, doctors are scared to death of the DEA and want you out of the office as fast as possible. I had one PM doc, say I really hate putting my name on that script. Record keeping is hap- hazard, every time I leave the office either the script is written wrong or my exam is documented improperly. I am sorry for myself and sorry for millions of others for the way we are being handled. Government has no business being involved, leave treatment to the ones that went to be trained for it and stop with the threats of losing their license or closing their practice for taking care of their patients the proper way.

Today because of the current Prohibition (The Obama Act) on opioid analgesics, the amount of prescriptions are down 40%. Although prescription opioids are down, the number of opioid overdoses and deaths are dramatically up. Unfortunately for our country, the amount of far more dangerous drugs, i.e., Heroin and Fentanyl are soaring off the charts. Chronic pain patients have an opportunity to replace their highly effective opiate meds with Marijuana and stay intoxicated (stoned) 24/7.

Altogether not a get result since the average opioid addict is 23 years old and they are dying from Fentanyl and Heroin that makes Oxycodone look like a baby aspirin by comparison. I find it a bit strange that since Heroin is a schedule 1 drug with no medicinal value (except in Great Britain), that Fentanyl was ever legal considering it’s 50 times more powerful than Heroin.

In 1920 when Prohibition ( Volstead Act) took effect, the vacuum was filled by organized crime and bootleggers to supply the country with a drug that was highly addictive and destructive, especially when dealers took short cuts by making their bathtub gin out of wood alcohol, resulting in death. Al Capone got rich and so did Joseph P. Kennedy Sr., who also stayed in the booze business after the end of Prohibition.
What I find interesting besides the repeat of history, is the creation of Medical Alcohol Cards/prescriptions during the 1920’s.

The major difference today as opposed to the Volstead Act, is the medical necessity for those of us in unrelenting 24/7 pain. We are not looking to get high, stoned, or intoxicated. We simply want to live. Just Live.

We all know the truth. The vast majority of misuse or overdoses are coming from once health people that have made a decision to destroy their lives.

Drug addicts don’t care if they live or die, they just want to get high.

If the government is successful re-educating (propaganda) healthcare providers that all Chronic Pain Patients now suffer from the brand new illness “Opioid Use Disorder” per the Surgeon General, there are major investment groups poised to make huge $$$. Please take a quick look at the links.

I just watched an episode of Drugs Inc. that described the massive influx of Herion and Fentanyl in Chicago and New York. Drug dealers will lace Fentanyl with Heroin deliberately to cause a few overdoses. Appearently drug addicts are attracted to the “Good Stuff” that’s pure enough to cause an overdose.

Our government is ounce again putting money before it’s citizens. IT’S INSANE!

O my gosh, I knew Phoenix House was the catalist of the “so called opiote abuse epidemic” so he says. I will be a dead woman at age 63 with chronic pain 24-7 which has been my life since I was permanently injured by another’s hands 30 years ago. This is if I don’t get my daily medication.
I saw him on the stock market on the morning of his big announcement.

I had no idea he was involved in Phoenix House. I was taken back when he made a statement to the fact of something like this “when we were prescribing opiates early on……we had no idea they were addictive.” I say Bullhooie – you knew exactly, and so did all the other Drs – knew they were addictive. I remember my Spine surgeon and I discussing it in 1991, in great depths, about the addiction of opiates. I discussed with him these words exactly. I told my spine surgeon almost, most of the 30 years I’ve been taking my opiates, that I would rather have a quality of life verses the quantity of my life. Which I still hold true to this very day. I pay for my medical and my prescriptions with my Medicare and money out of my pocket every month since I was put on Medicare Disability over 30 years ago. I still take the same medication, because it works for me & I follow my directions from my doctor. Today I got to sit on the ground and plant a few begonia’s! What a wonderful day, but I’m paying for the hand digging. I’m all swollen, arm all red and in pain. I have RSD in my right arm, shoulder, hand. I’m right hand dominate as well. This is in addition to many other spinal issues.
So when that Surgeon General stated that statement, I’m thinking, hum…I knew about opiates in the early 1990’s, so why have you not known about the effects of this medication? I still don’t believe – I’m being denied medication that I need. I still live in the United States, what about my rights as a chronic pain suffer? I think this man is a fraud and should be investigated. I wonder what his next plan is, when 1 million people who suffer from chronic pain start speaking up louder than we few people here??? All I can say is, God help us all!

This post doesn’t mention if they are attributing causation on either side. It’s clear that pain causes anxiety – how could it not?? But there have been studies that anxiety (esp. chronic anxiety) causes neurologic hypersensitivity that might make pain worse… so if they are aiming to disrupt a pain channel (ie: treat pain, just not with opioids) I think it’s worth following up. If they are trying to get people less anxious but leaving the pain, I agree with others that perhaps reducing the fear of losing needed pain meds would be a cheaper alternative.

Pain Stress and Anxiety go hand in hand. This is a very sensitive subject to many pain patients who have been abused by biased doctors who believe pain to be psycho somatic particularly in women ages 19-45. Instead of being treated for pain and disease they’re labeled drug seekers and sent to therapy handed loads of ineffective antidepressants and become ostracized from the medical community. There’s a reason opioids and benzo type medications have stood the test of time, they work. The more positive research, like this report here, are needed. If it can save just 1 woman from going through the medical abuse I went through before my blood cancer was discovered, it’s worth every penny.

Dr. Andrew Kolodny, Big Shot (BS) of Phoenix House, currently has 60 locations nationwide. Positioned to make a Fortune $$$ from former Chronic Pain Patients who recently were told they have a brand new disease ~ Opioid Use Disorder.

I always told my husband that anxiety & stress is a constant contributor to my chronic pain. The biggest is living daily not knowing if I will have my medication I need to maintain a sense to function with my opioids & muscle relaxer to assist in moving or not. Everything the government is doing to stop the drug use of opioids patients has affected me greatly. I feel like the government is trying to kill me, to get rid of an opioid user. I too am speaking for myself. Since this has began for me, November 2015, my entire life has changed for the worse. I have been taking the same medication for 30 year & it still works for me, because I follow my prescriptions. I have spinal pathology & there is no way to fix it. Believe me I have tried everything possible. The only relief I get is from my medication. Not 100% relief but it’s tolerable. I can stand up and then function from there. Don’t take my medication away from me, it works for me to live.

That should have been blatantly obvious to the most casual observer! It was easily seen in anyone that talked to their chronic pain patients. Just as the complaints that come with the change in the weather, or the seasons, seem to be going over their heads! They act surprised that depression is a large part of the problems a chronic pain patient faces. Who in the world would be happy about hurting, then having to fight to get relief! Too many, doctors talk at the patients and do not discuss their, most obvious, complaints!

Besides having to live daily with pain, those of us with chronic pain have to put up with negative reactions from friends, family, and coworkers; awful treatment from pharmacy staff; not knowing when your doctor is going to give in to the fear and hysteria regarding pain medications and stop prescribing them; while being portrayed by the mainstream media as the reason for the illegal opiate epidemic. What could we possibly have to be stressed about?

“Diazepam is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic health system.[9] The wholesale cost in the developing world is about 0.01 USD per dose as of 2014.[10] In the United States it is about 0.40 USD per dose.[5]”
Source. History of diazepam. Reference Wikipedia.

There is no doubt in my mind that stress is a major contributor to my pain. This past year running the gauntlet of anti opioid propaganda in regards to my doctors showed up in my last blood tests. I found that I suffer from Chronic Stress in addition to the list of my other physical concerns. Chronic stress brought on by the continuous worry of not knowing what to expect on my monthly doctor appointments.

The sword of Damocles hanging over my head for a year has lead to a decline in my health. Stress is without any doubt, the number 1 contributor to one’s health.
Good if controlled and very bad if not.

I can speak only for myself. The current unjust war on chronic pain patients, or more accurately articulated, the “Witch Hunt” has left me stressed out.

Of course chronic pain creates exiety!! ! It is unbearable and one feels anxiety from it. This is COMMON knowledge!!! Do not murder people by taking away the medicines they are on that works…. Eases the pain so one can function and does good for society with their time.